India’s focus must shift to a shorter regimen to tackle drug- resistant TB: Experts 

The theme for 2023 World Tuberculosis Day is Yes. We can end TB.

Experts have urged the government to speed up access to new, shorter and safer treatments of tuberculosis patients in India to tackle the increasing burden of drug-resistant tuberculosis cases.

“In high TB-burden countries including India, the availability of a six month, all-oral regimen for the treatment of people with drug- resistant TB can be a game-changer in ensuring that more patients can start and complete treatment sooner, with better outcomes and fewer side-effects,” said Animesh Sinha, HIV/TB/Hepatitis Advisor at Médecins Sans Frontières (MSF), or Doctors Without Borders (MSF), UK.

Implementation of the BPaLM (Bedaquiline, Pretomanid, Linezolid and Moxifloxacin) regimen for treatment of drug-resistant TB will reduce the burden on the health system, he said.

“We urge the Indian government to take immediate, necessary steps to roll out this regimen and save more lives,” Sinha added.

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In the current regimen in India, up to 14 pills are given to a TB patient daily for a period of 18 months.

In proposed new drug guidelines, the World Health Organisation has proposed the shorter BPaL (Bedaquiline, Pretomanid and Linezolid) and BPaLM.

Drug-resistant TB occurs when bacteria become resistant to the drug used to treat the disease, rendering the drug ineffective in killing the bacteria, which spreads the same way that drug-susceptible TB spreads: through the air from one person to another. In 2018, India had an estimated 130,000 drug-resistant TB cases, according to the website TBFACTS. org.

The BPaL regiment is recommended for pre- Extensively-Drug-Resistant (pre-XDR) TB patients and the BPaLM for multi-drug-resistant TB patients.

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The newer regimen for treatment of tuberculosis has a higher success rate and can also save money being spent by the government on patients, said Sandeep Juneja, Senior Vice President, Market Access, at TB Alliance, a not-for-profit drug development partnership.

“India needs to switch to modern treatments recommended by WHO (World Health Orgainisation). It's the youngest country in the world. It's at the cutting edge of technology in everything. So why shouldn’t India's TB patients get the best medicine,” he said.

The VP of TB Alliance said India can save up to $150 million per year by switching to the newer, shorter regimen for treating tuberculosis.

Juneja added that the prolonged treatment protocol adopted by India had a lower success rate than the newer regimen.

“Currently, the TB patients are given 13 to 14 drugs daily for a period of 18 months, which has a success rate of 55 to 57 percent. In the newer treatment regimen, the drug consumption time is cut down to six months, a patient has to take a smaller number drugs, and to add, the new treatments have success rate of 90 percent,” he added.

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According to an official in the health ministry, the government has also been working for a shorter regimen that will be announced by the Prime Minister.

“Officials from the National TB Elimination Programme (NTEP) have submitted the protocols of shorter treatment guidelines to the ministry of Health and Family Welfare and the Drugs Controller General of India,” the official said.

The official said that a pan-India rollout of a shorter TB Preventive Treatment (TPT) was in the pipeline. He didn’t say if India would adopt the shorter oral regimen for TB treatment.

“As per the Global TB Report, 2022, the incidence of TB in India has reduced by 18 percent from 256/lakh population in 2015 to 210/lakh population, which is 7 percentage points better than the global average of 11 percent,” he added.